Autologous Bone Marrow Transplantation - Blog Science Connections

232 ABMT for Advanced Hodgkin's Disease
MATERIALS AND METHODS
Twenty-seven patients were treated (median age, 31 years; range, 15-57
years). All had undergone previous chemotherapy, and seven (26%) had
undergone prior standard radiation therapy. Prior chemotherapy was extensive,
the median number of different chemotherapy agents used by each patient
prior to intense therapy being eight; only two patients (7%) had received fewer
than seven drugs. Only two patients could be classified as not being resistant to
initial therapy (they had disease-free intervals greater than 1 year) or as not
having salvage chemotherapy with a regimen non-cross-resistant to the initial
combination chemotherapy that failed. The median number of sites of disease
was two (range, one to seven), disease generally being limited to the
mediastinum or peripheral lymph nodes.
Patients were treated on a succession of protocols. All patients received
cyclophosphamide (60 mg/kg/day) intravenously for 2 days (days -5 and -4)
followed by total body irradiation (TBI). Total body irradiation was initially given
as 10 Gy for one fraction (day 1) or fractionated as 2 Gy twice a day for 3 days
(days -3, -2, and -1) for a total dose of 12 Gy (FTB1). Involved-field radiotherapy
(1FR), as 20 Gy given over 10-14 days before cyclophosphamide and TBI was
administered, provided greater than 90% of the tumor could be safely
encompassed in standard radiation ports. Patients who had received prior
standard radiotherapy were generally not eligible for the IFR boost because
excessive cumulative doses to normal tissues could be anticipated with the
subsequent TBI. Nineteen patients (70%) received IFR, cyclophosphamide, and
FTBI.
Marrow was collected, cryopreserved, and infused as previously described
(5). Transplantation took place the day after the patient completed TBI (day 0).
Complete remission was defined as the disappearance of tumor according
to all indexes and survival to day 30. Disease-free survival and total survival rates,
calculated from day 0 and analyzed as of September 1,1986, were estimated by
the product limit method of Kaplan and Meier (6).
RESULTS
Nineteen patients (70%) had a complete remission. The other eight
patients had a lower or no response to therapy. Six patients (22%) died as a
result of therapy-induced toxicity (interstitial pneumonia, infection, or hemorrhage),
four of whom were in complete remission. Four of the complete
responders have relapsed, leaving 11 patients still in continued complete
remission 3-47 months after transplantation. Of the four patients who relapsed,
one is alive at 48 months in a second remission induced by local radiation
therapy, two are alive at 8 and 28 months with progressive disease, and one has
died at 42 months. All patients with less than a complete response to therapy
have died of progressive disease or toxicity. The estimated probability of
disease-free survival, with all deaths in remission counted as owed to tumor, is